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Are there socioeconomic inequalities in polypharmacy among older people? A systematic review and meta-analysis

Iqbal, Anum; Richardson, Charlotte; Iqbal, Zain; O’Keefe, Hannah; Hanratty, Barbara; Matthews, Fiona E.; Todd, Adam

Authors

Anum Iqbal

Charlotte Richardson

Zain Iqbal

Hannah O’Keefe

Barbara Hanratty

Adam Todd



Abstract

Background: Socioeconomic status (SES) may influence prescribing, concordance and adherence to medication regimens. This review set out to investigate the association between polypharmacy and an individual’s socioeconomic status. Methods: A systematic review and meta-analyses of observational studies was conducted across four databases. Older people (≥ 55 years) from any healthcare setting and residing location were included. The search was conducted across four databases: Medline (OVID), Web of Science, Embase (OVID) and CINAHL. Observational studies from 1990 that reported polypharmacy according to SES were included. A random-effects model was undertaken comparing those with polypharmacy (≥ 5 medication usage) with no polypharmacy. Unadjusted odds ratios (ORs), 95% confidence intervals (CIs) and standard errors (SE) were calculated for each study. Results: Fifty-four articles from 13,412 hits screened met the inclusion criteria. The measure of SES used were education (50 studies), income (18 studies), wealth (6 studies), occupation (4 studies), employment (7 studies), social class (5 studies), SES categories (2 studies) and deprivation (1 study). Thirteen studies were excluded from the meta-analysis. Lower SES was associated with higher polypharmacy usage: individuals of lower educational backgrounds displayed 21% higher odds to be in receipt of polypharmacy when compared to those of higher education backgrounds. Similar findings were shown for occupation, income, social class, and socioeconomic categories. Conclusions: There are socioeconomic inequalities in polypharmacy among older people, with people of lower SES significantly having higher odds of polypharmacy. Future work could examine the reasons for these inequalities and explore the interplay between polypharmacy and multimorbidity.

Citation

Iqbal, A., Richardson, C., Iqbal, Z., O’Keefe, H., Hanratty, B., Matthews, F. E., & Todd, A. (2023). Are there socioeconomic inequalities in polypharmacy among older people? A systematic review and meta-analysis. BMC Geriatrics, 23(1), Article 149. https://doi.org/10.1186/s12877-023-03835-z

Journal Article Type Article
Acceptance Date Feb 20, 2023
Online Publication Date Mar 18, 2023
Publication Date Dec 1, 2023
Deposit Date Jan 4, 2024
Publicly Available Date Jan 5, 2024
Journal BMC Geriatrics
Print ISSN 1471-2318
Electronic ISSN 1471-2318
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 23
Issue 1
Article Number 149
DOI https://doi.org/10.1186/s12877-023-03835-z
Keywords Medication usage; Socioeconomic status; Health inequalities; Polypharmacy; Ageing; Meta-analysis
Public URL https://hull-repository.worktribe.com/output/4496250

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http://creativecommons.org/licenses/by/4.0

Copyright Statement
© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
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licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.




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